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Dropped Coverage

Nobody could accuse the press of ignoring the fiasco-on-a-server that is HealthCare.gov. The Obamacare website’s woes are dominating coverage on the network news, the cable talk shows, the blogs and, of course, high-octane websites like POLITICO.

But did the press do a good job of covering the Affordable Care Act before the health care exchanges went online—sort of—on Oct. 1? Were we adequately warned of the troubles that were to come? And now that HealthCare.gov’s problems are headline news, is the coverage of it any better?

Sure, one can find a few examples of one news outlet or another warning of impending catastrophe. In March, CQ’s Jane Norman reported that federal health officials were working on “contingency plans” in case the exchanges didn’t work. She quoted two: Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, who said he was “pretty nervous” about the rollout, and Centers for Medicare and Medicaid Services official Henry Chao, who said, “Let’s just make sure it’s not a third-world experience.” A few conservative sites picked up the quotes, as did National Journal a few days later, warning flatly: “Prepare for disaster.”

But a June report by the Government Accountability Office failed to sound the alarm, noting dryly: “Much progress has been made, but much remains to be accomplished within a relatively short amount of time”—and the coverage of it was accordingly muted. POLITICO did note that “IT could end up being health reform’s highest hurdle.” The Washington Post, in August, and the New York Times, in late September, highlighted problems with the state exchanges, but not the more serious internal concerns about HealthCare.gov. Overall, the press was not very prescient, not just about the ACA’s looming tech problems, but also in informing readers and viewers about this admittedly complicated bill’s downstream consequences.

So when the law actually came into effect on Oct. 1, Americans were by and large not prepared—not for the website when it froze up and not for the millions of cancellation notices that went out to Americans in the individual insurance market. The news hit like a bomb—and the political impact hit that much harder for the Obama administration. Why hadn’t the media caught wind of HealthCare.gov’s troubles? Had President Obama lied when he promised, “If you like your health care plan, you can keep your health care plan." And if so, why didn’t the media call him on it at the time?

One obvious reason: Health policy is tough stuff. Since 2007, I have written more than 700 posts for the Columbia Journalism Review examining the coverage of health reform, starting with the debates of the 2008 election and long beyond. From this perch, I’ve seen most of what the press has sent out to the public during the debate over the Affordable Care Act through its implementation last month. And I have to say: With a few exceptions, much of it has been dismal.

Some of that is inherent to the subject matter. “There’s been a tension between trying to talk about the law without boring people and making the explanations too complicated,” explains Josh Archambault, a senior fellow with the Foundation for Government Accountability, a conservative think tank active in state capitals.

There’s no question most of us failed to dig into the most basic question of all: Would the darn thing work?

But it’s more than that. Although the media spoke or wrote zillions of words about the ACA, relatively few explained in meaningful ways what the law was all about, who would be affected by it and how—in short, how would it affect peoples’ lives and why they should care. The media, for the most part, fell down on the job when it came to dissecting the promises made by supporters (for example, that people could keep their insurance and their doctors); who would pay for the subsidies; why essential benefits were important; and why there had to be an individual mandate with penalties for not buying insurance. And there’s no question most of us failed to dig into the most basic question of all: Would the darn thing work?

What the press delivered instead was mostly a conversation among policy wonks and Beltway political elites without letting in the people who would be most affected by the nostrums they were prescribing. The public was the victim of a messaging war, with much of the conversation shaped by spin and talking points. And as in all wars, truth is the first casualty. Americans needed clear, direct explanations, honesty, dot connection and a probe of the carefully crafted words that came to define the debate. Yes, there were plenty of fact-checkers keeping watch, but as press critic and political scientist Brendan Nyhan has pointed out, these services can fall short. Their one-the-one hand, on-the-other hand format often confuses more than illuminates. Against this backdrop, the backlash of the last few weeks was probably inevitable.